Risk factors for suicide attempt among Israeli Defense Forces soldiers: A retrospective case-control study

•The study examined risk factors for suicide attempts among Israeli soldiers.•Known risk factors were verified.•More frequent meetings with primary physicians associated with higher risk.•More frequent meetings with mental health care personnel associated with lower risk.•Training physicians as professional gatekeepers is emphasized through the results.

BackgroundA major risk factor for suicide is suicide attempts. The aim of the present study was to assess risk factors for nonfatal suicide attempts.MethodsThe study's cohort consisted of 246,814 soldiers who were divided into two groups: soldiers who made a suicide attempt (n=2310; 0.9%) and a control group of soldiers who did not (n=244,504; 99.1%). Socio-demographic and personal characteristics as well as psychiatric diagnoses were compared.ResultsThe strongest risk factors for suicide attempt were serving less than 12 months (RR=7.09) and a history of unauthorized absence from service (RR=5.68). Moderate risk factors were low socioeconomic status (RR=2.17), psychiatric diagnoses at induction (RR=1.94), non-Jewish religion (RR=1.92), low intellectual rating score (RR=1.84), serving in non-combat unit (RR=1.72) and being born in the former Soviet Union (RR=1.61). A weak association was found between male gender and suicide attempt (RR=1.36). Soldiers who met more frequently with a primary care physician (PCP) had a higher risk for suicide attempt, as opposed to a mental health professional (MHCP), where frequent meetings were found to be a protective factor (P<0.0001). The psychiatric diagnoses associated with a suicide attempt were a cluster B personality disorder (RR=3.00), eating disorders (RR=2.78), mood disorders (RR=2.71) and adjustment disorders (RR=2.26).LimitationsMild suicidal behavior constitutes a much larger proportion than among civilians and may have secondary gain thus distorting the suicidal behavior data.ConclusionsTraining primary care physicians as gatekeepers and improved monitoring, may reduce the rate of suicide attempts.